Gender Disparities in the Diagnosis of Sleep Disordered Breathing

Introduction: Current diagnostic guidelines for sleep disordered breathing (SDB) require that apneas and hypopneas be accompanied by a 4% desaturation for it to constitute a respiratory event (AHI-Accepted). However, the American Academy of Sleep Medicine recommends expanding the diagnostic criteria to include apneas and hypopneas accompanied by a 3% desaturation or a cortical arousal for diagnosis (AHI-Recommended). We hypothesized that a clinical sample of both men and women would demonstrate that women are more likely to be misdiagnosed using the accepted criteria compared to the recommended criteria. Methods: The clinical sample consisted of all patients receiving a PSG at the Detroit Medical Center Sleep Clinic in 2019. We used t-test calculations to analyze gender, BMI, AHI-R, and AHI-A. Results: 286 Women and 158 Men were analyzed. For Women, the average AHI-R was 27.0 events/hr (±27.4), and AHI-A was 15.1 events/hr (±21.4). For Men, the average AHI-R was 47.1 events/hr (±35.1), and AHI-A was 32.5 events/hr (±31.9). 19.8% of women had an AHI-A greater than 15 compared to 35.3% of women when using AHI-R (15.5% increase). For men, 20.5% had an AHI-A greater than 15 compared to 27.4% when using AHI-R (6.9% increase). Discussion: There was a significant difference between men and women when comparing AHI-A to AHI-R. Using the AHI-R criteria resulted in a greater increase in women being diagnosed with severe SDB compared to men. This indicates that using the recommended criteria benefits women to a greater extent than men

Wastewater Reclamation in Major Jordanian Industries: A Viable Component of a Circular Economy

Water scarcity remains the major looming challenge that is facing Jordan. Wastewater reclamation is considered as an alternative source of fresh water in semi-arid areas with water shortage or increased consumption. In the present study, the current status of wastewater reclamation and reuse in Jordan was analyzed considering 30 wastewater treatment plants (WWTPs). The assessment was based on the WWWTPs’ treatment processes in Jordan, the flowrates scale, and the effluents’ average total dissolved solid (TDS) contents. Accordingly, 60% of the WWTPs in Jordan used activated sludge as a treatment technology; 30 WWTPs were small scale (<1 × 104 m3/day); and a total of 17.932 million m3 treated wastewater had low TDS (<1000 ppm) that generally can be used in industries with relatively minimal cost of treatment. Moreover, the analysis classified the 26 million m3 groundwater abstraction by major industries in Jordanian governorates. The results showed that the reclaimed wastewater can fully offset the industrial demand of fresh water in Amman, Zarqa, and Aqaba governorates. Hence, the environmental assessment showed positive impacts of reclaimed wastewater reuse scenario in terms of water depletion (saving of 72.55 million m3 groundwater per year) and climate change (17.683 million kg CO2Eq reduction). The energy recovery assessment in the small- and medium-scale WWTPs (<10 × 104 m3/day) revealed that generation of electricity by anaerobic sludge digestion equates potentially to an offset of 0.11–0.53 kWh/m3. Finally, several barriers and prospects were put forth to help the stakeholders when considering entering into an agreement to supply and/or reuse reclaimed water

CXCR 3 expression on CD4+T cells and in renal tissue of pediatric systemic lupus erythematosus patients

Background: Pediatric systemic lupus erythematosus (pSLE) accounts for about 20% of all cases of Systemic Lupus Erythematosus (SLE), with nephritis occurring in approximately 50% of the patients. Objective: to evaluate the expression of CXCR3 in the kidneys and on CD4+ T cells in pSLE. Methods: This study was conducted on 45 patients with pSLE following up at the Allergy and Immunology Clinic, Children’s Hospital, Ain Shams University and 45 age and sex matched healthy children as a control group. Medical history, clinical examination and routine laboratory investigations for assessment of disease activity were done for all patients, the frequency of CXCR3, CD4+ T cells was determined in all patients and controls. Twenty-five Paraffin blocks of patients with lupus nephritis (LN) (available at the time of the study) underwent immunohistochemistry staining for the frequencies of Chemokine C receptor (CXCR3). Results: The absolute level and percentage of serum CD4+CXCR3+ were significantly lower among our patients as compared to healthy controls. A significant direct correlation was found between serum CD4+CXCR3+ and both the lymphocytic count and quantitative Systemic Lupus erythematosus disease activity index (SLEDAI), as well as a significant inverse correlation between it and 24 hours urinary proteins. Variable degrees of CXCR3expression seemed to have no impact on laboratory tests, British Isles Lupus Assessment Group (BILAG) score and cumulative doses of Immunosuppressives. Conclusion: Serum CD4+CXCR3+ and not renal CXCR3 may be a potential marker of LN activity

Membrane endothelial protein C receptor expression in renal tissue of pediatric lupus nephritis patients

Background: Lupus nephritis (LN) is more common and more severe is pediatric systemic lupus erythematosus (pSLE). Endothelial protein C receptor (EPCR) is an inducer of anti-apoptotic pathways in endothelial cells. Recent studies have taken elevated anti-injury biomarkers as EPCR into consideration regarding their roles to antagonize LN.Objectives: to evaluate the membrane expression of endothelial protein C receptor (mEPCR) in the renal microvasculature in pediatric patients with LN.Methods: This study was conducted on 25 patients with pSLE following up at the Allergy and Immunology Clinic, Children’s Hospital, Ain Shams University. The 25 patients have LN proved by a previous renal biopsy. Medical history, clinical examination and routine laboratory investigations for assessment of disease activity were done for all patients. Paraffin blocks of patients’ renal biopsies were subjected to immunohistochemistry staining for the frequency of mEPCR.Results: mEPCR was mainly expressed in the endothelium of the peritubular capillaries. Our results showed that an equal number of patients had nil and mild marker expression (8 patients each, 32%) while 9 patients (36%) showed moderate/strong marker expression. We found that 9 out of 10 (90%) of patients with class II had nil/mild marker expression, 5 patients out of 9 (55.5%) with class III had mild/moderate marker expression, while 5 patients 0ut of 6 (83.3%) with class IV and V had moderate/strong marker expression. We only found a significant statistical difference between the different degrees of mEPCR expression regarding 24 hours urinary proteins. No statistical significance was found between the different degrees of mEPCR expression and different immuno-suppressive therapy dose/kg or renal outcome using the renal British Isles Lupus Assessment Group (BILAG) score; in spite that most of the patients who got improved had nil/mild marker expression.Conclusion: mEPCR -bearing a statistically significant difference in relation to different LN classes- showed more expression in the more aggressive classes; a finding which might suggest a contribution of the endothelium of the renal parenchyma to the pathophysiology of more progressive LN. Hence the tissue marker might emerge as a potential new therapeutic target in the search for more selective treatment for SLE.Keywords: p SLE, mEPCR, renal biopsy, immunohistochemistry, BILAG, lupus nephriti

Accountable privacy preserving attribute based framework for authenticated encrypted access in clouds

In this paper, we propose an accountable privacy preserving attribute-based framework, called Ins-PAbAC, that combines attribute based encryption and attribute based signature techniques for securely sharing outsourced data contents via public cloud servers. The proposed framework presents several advantages. First, it provides an encrypted access control feature, enforced at the data owner’s side, while providing the desired expressiveness of access control policies. Second, Ins-PAbAC preserves users’ privacy, relying on an anonymous authentication mechanism, derived from a privacy preserving attribute based signature scheme that hides the users’ identifying information. Furthermore, our proposal introduces an accountable attribute based signature that enables an inspection authority to reveal the identity of the anonymously-authenticated user if needed. Third, Ins-PAbAC is provably secure, as it is resistant to both curious cloud providers and malicious users adversaries. Finally, experimental results, built upon OpenStack Swift testbed, point out the applicability of the proposed scheme in real world scenarios

Twelve-month observational study of children with cancer in 41 countries during the COVID-19 pandemic

Introduction Childhood cancer is a leading cause of death. It is unclear whether the COVID-19 pandemic has impacted childhood cancer mortality. In this study, we aimed to establish all-cause mortality rates for childhood cancers during the COVID-19 pandemic and determine the factors associated with mortality. Methods Prospective cohort study in 109 institutions in 41 countries. Inclusion criteria: children &lt;18 years who were newly diagnosed with or undergoing active treatment for acute lymphoblastic leukaemia, non-Hodgkin's lymphoma, Hodgkin lymphoma, retinoblastoma, Wilms tumour, glioma, osteosarcoma, Ewing sarcoma, rhabdomyosarcoma, medulloblastoma and neuroblastoma. Of 2327 cases, 2118 patients were included in the study. The primary outcome measure was all-cause mortality at 30 days, 90 days and 12 months. Results All-cause mortality was 3.4% (n=71/2084) at 30-day follow-up, 5.7% (n=113/1969) at 90-day follow-up and 13.0% (n=206/1581) at 12-month follow-up. The median time from diagnosis to multidisciplinary team (MDT) plan was longest in low-income countries (7 days, IQR 3-11). Multivariable analysis revealed several factors associated with 12-month mortality, including low-income (OR 6.99 (95% CI 2.49 to 19.68); p&lt;0.001), lower middle income (OR 3.32 (95% CI 1.96 to 5.61); p&lt;0.001) and upper middle income (OR 3.49 (95% CI 2.02 to 6.03); p&lt;0.001) country status and chemotherapy (OR 0.55 (95% CI 0.36 to 0.86); p=0.008) and immunotherapy (OR 0.27 (95% CI 0.08 to 0.91); p=0.035) within 30 days from MDT plan. Multivariable analysis revealed laboratory-confirmed SARS-CoV-2 infection (OR 5.33 (95% CI 1.19 to 23.84); p=0.029) was associated with 30-day mortality. Conclusions Children with cancer are more likely to die within 30 days if infected with SARS-CoV-2. However, timely treatment reduced odds of death. This report provides crucial information to balance the benefits of providing anticancer therapy against the risks of SARS-CoV-2 infection in children with cancer

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Extracorporeal Membrane Oxygenation for Severe Acute Respiratory Distress Syndrome associated with COVID-19: An Emulated Target Trial Analysis.

RATIONALE: Whether COVID patients may benefit from extracorporeal membrane oxygenation (ECMO) compared with conventional invasive mechanical ventilation (IMV) remains unknown. OBJECTIVES: To estimate the effect of ECMO on 90-Day mortality vs IMV only Methods: Among 4,244 critically ill adult patients with COVID-19 included in a multicenter cohort study, we emulated a target trial comparing the treatment strategies of initiating ECMO vs. no ECMO within 7 days of IMV in patients with severe acute respiratory distress syndrome (PaO2/FiO2 <80 or PaCO2 ≥60 mmHg). We controlled for confounding using a multivariable Cox model based on predefined variables. MAIN RESULTS: 1,235 patients met the full eligibility criteria for the emulated trial, among whom 164 patients initiated ECMO. The ECMO strategy had a higher survival probability at Day-7 from the onset of eligibility criteria (87% vs 83%, risk difference: 4%, 95% CI 0;9%) which decreased during follow-up (survival at Day-90: 63% vs 65%, risk difference: -2%, 95% CI -10;5%). However, ECMO was associated with higher survival when performed in high-volume ECMO centers or in regions where a specific ECMO network organization was set up to handle high demand, and when initiated within the first 4 days of MV and in profoundly hypoxemic patients. CONCLUSIONS: In an emulated trial based on a nationwide COVID-19 cohort, we found differential survival over time of an ECMO compared with a no-ECMO strategy. However, ECMO was consistently associated with better outcomes when performed in high-volume centers and in regions with ECMO capacities specifically organized to handle high demand. This article is open access and distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives License 4.0 (http://creativecommons.org/licenses/by-nc-nd/4.0/)

Alleviation of liver cirrhosis and associated portal-hypertension by Astragalus species in relation to their UPLC-MS/MS metabolic profiles: a mechanistic study

Abstract Liver cirrhosis is a late-stage liver disease characterized by excessive fibrous deposition triggering portal-hypertension (PH); the prime restrainer for cirrhosis-related complications. Remedies that can dually oppose hepatic fibrosis and lower PH, may prevent progression into decompensated-cirrhosis. Different Astragalus-species members have shown antifibrotic and diuretic actions with possible subsequent PH reduction. However, A.spinosus and A.trigonus were poorly tested for eliciting these actions. Herein, A.spinosus and A.trigonus roots and aerial parts extracts were subjected to comprehensive metabolic-fingerprinting using UHPLC-MS/MS resulting in 56 identified phytoconstituents, followed by chemometric untargeted analysis that revealed variable metabolic profiles exemplified by different species and organ types. Consequently, tested extracts were in-vivo evaluated for potential antifibrotic/anticirrhotic activity by assessing specific markers. The mechanistic prospective to induce diuresis was investigated by analyzing plasma aldosterone and renal-transporters gene-expression. Serum apelin and dimethylarginine-dimethylaminohydrolase-1 were measured to indicate the overall effect on PH. All extracts amended cirrhosis and PH to varying extents and induced diuresis via different mechanisms. Further, An OPLS model was built to generate a comprehensive metabolic-profiling of A.spinosus and A.trigonus secondary-metabolites providing a chemical-based evidence for their efficacious consistency. In conclusion, A.spinosus and A.trigonus organs comprised myriad pharmacologically-active constituents that act synergistically to ameliorate cirrhosis and associated PH

Measurement of 8-isoprostane in exhaled breath condensate of patients with chronic obstructive pulmonary disease

Background 8-Isoprostane is an accurate biomarker of oxidative stress. Despite 8-isoprostane concentrations in exhaled breath condensate (EBC) had showed higher values in chronic obstructive pulmonary disease (COPD), the association between EBC 8-isoprostane and different clinical and functional parameters of COPD remains debatable. For this reason, the aim of this study was to evaluate the relation between EBC 8-isoprostane and the clinical and functional parameters of COPD. Participants and methods A cohort had been conducted including 100 participants classified into two groups matched for age and sex. Group A (COPD group) included 80 COPDs with different Global Initiative for Chronic Obstructive Lung Disease (GOLD) stages; group B included 20 healthy controls. All COPD patients were assessed by high-resolution computed tomography of chest. Both groups had undergone spirometry, 6-min walk test, and SpO2 assessment. EBC collection and 8-isoprostane had been measured for all participants in the study. Results Moderate and severe stages constituted the majority of recruited COPD patients. 8-Isoprostane concentration was significantly higher in COPD patients compared with controls. Forced expiratory volume in first second (FEV1), 6-min walk test, and SpO2 showed inverse significant correlation with 8-isoprostane. 8-Isoprostane also had higher levels in COPD patients with very severe GOLD stage. Smoking and sex were not predictive factors of higher 8-isoprostane. Conclusion 8-Isoprostane is considered a sensitive and valuable biomarker measured in EBC, reflecting the intensity of the inflammatory process in COPD. 8-Isoprostane showed a significant positive correlation with COPD GOLD stage and negative correlation with lung function